PETER ARNOLD. Ethics and the AMA

Interestingly, the committee appointed by the Victorian government to report on ‘assisted dying’ was headed by the immediate past-president of the AMA, neurosurgeon Brian Owler. Neurosurgeons have a close connection with this problem when patients with severe head injuries have been on life-support for days or weeks with no apparent chance of meaningful survival.

The current president of the AMA, gynaecologist Michel Gannon, has, by contrast, declared the AMA’s official opposition to any such law. Gynaecologists work at the other end of the life cycle, bringing new lives into world. Perhaps, but only perhaps, Owler’s and Gannon’s attitudes relate to their polar positions in life’s cycle.

Here I am not debating the pros and cons of ‘assisted dying’. No, my focus is on the organisation of which both Owler and Gannon have been, or are, president, and of whose Federal Council I chaired for four years, a well as being president of the NSW AMA.

First, a little story.

In 1987, I was on the Council of AMA NSW and Chair of its Ethics Committee. A motion advocating either euthanasia or a more liberal approach to abortion (I have forgotten which of these ethical issues it was) was tabled before Council.

The immediate response from the many Catholic councillors was that they would resign from the AMA if the motion were carried. This prompted a countervailing response from the Protestant councillors that they would resign if the motion failed. As a Jew, in neither camp, I moved “the motion not be put”, to the immense gratitude of the president. This was carried unanimously.

The reason for my moving the procedural motion was because I was privy to the AMA’s precarious financial position.

Contrary to the belief of many, the AMA does not ‘represent’ Australia’s doctors. It has not done so for some 70 years. It merely ‘claims’ to do so.

There was a time when it did – in 1948 when its predecessor, the British Medical Association in Australia (as it then was, comprising state and territory BMA branches before the 1961 federation into the AMA) won its High Court challenge to the federal government on ‘civil conscription’ in respect of using government prescription pads.

Membership has since declined, until today the AMA ‘represents’ fewer than one-third of doctors, possibly only a quarter. As far back as September 1976, in response to Bob Hawke’s naïve description of it as “Australia’s most powerful” union, I explained, in Quadrant, the AMA’s lack of representativeness and of “power”.

Membership of the AMA is not only voluntary, but the large subscription is discretionary expenditure. Doctors are confronted by obligatory professional registration fees (now inflated by Labor’s catastrophic centralisation under the Australian Health Practitioner Regulation Authority), obligatory membership of their professional college, whether specialist or faux specialist (GP), often of their sub-specialty group, such as Dr Owler’s membership of the Neurosurgical Society of Australia, massive indemnity (medical negligence) insurance, and, like other independent professionals, obligatory attendance at costly continuing professional development courses, sickness and accident and life insurance and superannuation. Paying an AMA membership fee, for no financial benefit, comes last.

Furthermore, the AMA makes little or no effort to bring immigrant doctors into the fold. As a consequence, these groups have formed the independent Australian Chinese Medical Association, the Overseas Medical Graduates Organisation and the Australian Indian Medical Association.

The reality is that the AMA cannot afford to antagonise any significant section of its membership by taking a stand on any contentious ethical issue.

It is no surprise that Michael Gannon, maintaining the financially safe status quo, voices opposition to his predecessor’s proposals. The loss of its Catholic and other ‘orthodox’ Christian members would bankrupt the AMA.

Peter Arnold is a retired general practitioner. He was a prominent office bearer of the AMA from 1987 to 2000, having been active in medical politics since 1968. He has served on several committees and boards relating to quality of care, medical registration and discipline.

Thank you Peter for some important observations about the AMA and its low membership. Unfortunately there is substantial evidence to counter the claim that Michael Gannon’s opposition to voluntary assisted dying is because the AMA is not taking a stand on ‘any’ contentious ethical issue and he may just be protecting the financially safe ‘status quo’ of the AMA:
1. On 20 May 17 the AMA called on the Australian Parliament to legislate for marriage equality. (https://ama.com.au/media/ama-calls-marriage-equality) When the entirely predictable backlash came via Dr Chris Middleton, a former president of the Tasmanian AMA and others, Michael Gannon defended the pro-marriage equality stand (See http://www.theaustralian.com.au/news/nation/ama-misleading-on-gay-marriage/news-story/ad30aaab46c4e97472fa7d7523a09f34 and https://www.doctorportal.com.au/amas-marriage-equality-stance-slammed/)
2. At the time of the debate on the Victorian Voluntary Assisted Dying Bill, Michael Gannon made tweets which were criticised by AMA Victoria as disrespectful (https://www.theguardian.com/society/2017/oct/18/victoria-ama-criticises-federal-president-over-insensitive-assisted-dying-tweets).
3. At no time during the Victorian debate, or at the time of the Tasmanian Voluntary Assisted Dying Bill debate in May 17, has Michael Gannon and other AMA representatives made clear the substantial support of voluntary assisted dying by AMA members. The survey of AMA members found: “More than half of respondents (52%) believe euthanasia can form a legitimate part of medical care and 45% believe the same for physician assisted suicide (Survey Questions 11 and 20)”.
4. AMA Tasmania refused the repeated invitations by the proponents of the Tasmanian Voluntary Assisted Dying Bill, Lara Giddings and Cassy O’Connor, to meet, discuss and provide input. Instead, Dr Chris Middleton led AMA opposition providing a presentation to Liberal MPs the day before the debate, along with other well known religious opponents, and a representative of Dr Gannon’s, Dr Chris Moy. It will be interesting to see whether there is any change in AMA Tasmania’s approach to the next Tasmanian Voluntary Assisted Dying Bill now that Dr Middleton has resigned from the AMA over the marriage equality issue.

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